The Council for Medical Schemes

There are close to 100 medical aids in South Africa and nearly 8 500 000 beneficiaries with an annual contribution of more than R84 billion. This huge industry needs a watchdog and that role is filled by the Council for Medical Schemes.

It’s a statutory body that was created in 1998 with the intention to regulate the country’s private medical aid industry.

It also guarantees that beneficiaries receive fair treatment and have access to the benefits stipulated in the rules of their individual health insurance scheme or hospital plan.

 

The council

The Minister of Health appoints a board that consists of 15 members, including a non-executive chairman and a deputy chairman, who serve on a part-time basis, for a maximum of three years.

This board is referred to as the Council and its members meet on at least four occasions annually. Council for Medical SchemesMembers are chosen from diverse backgrounds and they represent a cross section of skills that range from law to consumer affairs. They are responsible for the overall policy of the Council for Medical Schemes.

The daily decision-making and supervision of staff is done by an executive committee that holds monthly meetings. They are also responsible for informing the general public, stakeholders and media organisations of the work of the Council.

This management team consists of executive managers and the Chief Executive who is referred to as the Registrar. The Registrar is also elected by the Health Minister.

 

The role of the Council:

  • Safeguards the interests of medical aids and their members
  • Monitors the solvency and financial status of these medical institutions
  • Investigates complaints and finds resolutions to disputes
  • Collects and circulates data about South Africa’s private health care sector, including health insurance costs
  • Ensures that various private medical aids comply with national health policies
  • Creates rules and guidelines, in accordance with the Medical Schemes Act, about the Council’s own purpose and authority
  • Makes recommendations to the Health Minister about the services provided by the country’s medical aid companies
  • Informs the general public about their rights to ensure they receive the best health insurance they can afford

 

Lodging complaints 

A primary role of the Council is to assist any person who is unhappy with the actions of a medical aid. If this person belongs to a medical aid, their first course of action is to contact and lodge a complaint with that particular company.

If there is no resolution or the complainant is unsatisfied with the result, then they can contact the Council for Medical Schemes Complaints Unit who will investigate their grievance without requesting any fees.

If this person is not satisfied with the decision made by the Registrar then they can lodge a plea with the Appeal Board. This step requires payment of a fee.

A person who has a complaint about their health cover insurance or the medical aid industry can submit their objections through a written letter, by sending a fax or e-mail or visiting the CMS in person.

 

Contact information:

General:

Customer Care Service Centre: 0861 123 267

Reception Telephone: (012) 431 0500

Fax: (012) 430 7644

Email Enquiries: support@medicalschemes.com

 

Complaints:

Email: complaints@medicalschemes.com

Fax: (012) 431-0608

The complaints procedure can be found on the Council for Medical Schemes website.

 

Postal address:

Private Bag X34

Hatfield

0028

 

Physical Address:

Hadfields Office Park, Block E

1267 Pretorius Street

Hatfield

0028

 

GPS Coordinates: 

Latitude   : S 25 44 40.0992

Longitude : E 28 14 37.3344